Endosurgical Intrapuborectal Reconstruction of High Anorectal Anomalies

Abstract

Different morphological findings in anorectal anomalies necessitate different operative procedures. The classification of anorectal anomalies into supralevator, intermediate, and infralevator types (27 anorectal anomalies) enables one to find the appropriate surgical procedure corresponding to anatomical morphological findings. Within the last 25 years in 328 newborns and babies, anorectal anomalies have been treated surgically. For high anorectal anomalies, the abdominoperineal pull-through procedure has been performed (n = 105). Since 1984 we determine the puborectalis/levator sling by direct vision with the help of intraoperative endoscopy. In two children, the whole abdominal procedure was performed laparoscopically, and the anastomosis was performed extra-abdominally in front of the perineum. The results were controlled by sector manometry and intra-anal ultrasound. The continence results so far are identical to those using the conventional procedure.